A Comprehensive Patient Blood Management Program During Cardiopulmonary Bypass in Patients Over 60 Years of Age

Figures & data

Figure 1 Flow chart of the study cohort.

Abbreviations: LVAD, left ventricular assist device; PBM, patient blood management.

Table 1 Basic Characteristics Between Two Groups After Matching

Variables	Pre-PBM (n=3611)	Post-PBM (n=3611)	SMD
Preoperative characteristics
Age, y	66 (63,69)	66 (63,69)	0.055
Male sex	2324 (64.4)	2305 (63.8)	0.013
BMI, kg/m^2	25 (23,27)	25 (23,27)	0.043
EuroSCORE	3 (2,5)	3 (2,5)	0.019
EF, %	60 (58,65)	60 (59,63)	0.065
Previous myocardial infarction	437 (12.1)	442 (12.2)	0.003
Diabetes	909 (25.2)	898 (24.9)	0.007
Hypertension	2087 (57.8)	2023 (56.0)	0.036
Hyperlipidemia	2154 (59.7)	2110 (58.4)	0.026
Chronic lung disease	63 (1.7)	66 (1.8)	0.008
Renal dysfunction	21 (0.6)	26 (0.7)	0.012
Previous cardiac surgery	90 (2.5)	75 (2.1)	0.027
Smoking	1477 (40.9)	1435 (39.7)	0.024
Hemoglobin^a, g/L	133 (126,142)	133 (124,144)	0.002
Hematocrit^a, l/L	0.40 (0.38,0.42)	0.40 (0.37,0.42)	0.094
Platelets^a, ×10^9/L	194 (167,227)	194 (162,233)	0.007
Creatinine^a, μmol/L	82 (72,90)	83 (73,94)	0.091
Operative characteristics
Surgery type
CABG only	1717 (47.5)	1563 (43.3)	0.084
Valve surgery only	743 (20.6)	917 (25.4)	0.114
CABG+valve surgery	454 (12.6)	375 (10.4)	0.069
Major aortic surgery	370 (10.2)	451 (12.5)	0.073
Other	327 (9.1)	305 (8.4)	0.025
CPB time, min	103 (82,131)	107 (84,136)	0.065

Notes: Continuous variables are reported as medians (25th percentile, 75th percentile), categorical variables reported as number (%). ^aLaboratory test values show the last preoperative test.

Abbreviations: BMI, body mass index; CABG, coronary artery bypass grafting; CPB, cardiopulmonary bypass; EuroSCORE, European System for Cardiac Operative Risk Evaluation; EF, ejection fraction; SMD: standardized mean difference.

Table 2 Transfusion Results and Clinical Outcomes After Matching

Variables	Pre-PBM (n=3611)	Post-PBM (n=3611)	P value
Transfusion results
RBC transfusion during CPB^a	1142 (31.6)	473 (13.1)	<0.001
Intraoperative RBC transfusion^b	1835 (50.8)	1410 (39.0)	<0.001
Postoperative RBC transfusion^c	202 (5.6)	113 (3.1)	<0.001
Clinical outcomes
30-day mortality	36 (1.0)	23 (0.6)	0.048
Complications
Combined complications^d	627 (17.4)	545 (15.1)	0.009
Prolonged mechanical ventilation	260 (7.2)	255 (7.1)	0.819
Cerebrovascular accident	26 (0.7)	27 (0.7)	0.89
AKI	281 (7.8)	212 (5.9)	0.001
Excessive chest drainage	184 (5.1)	105 (2.9)	<0.001
Pulmonary infection	95 (2.6)	107 (2.9)	0.089
IABP insertion	34 (0.9)	33 (0.9)	0.902
Re-sternotomy	113 (3.1)	79 (2.2)	0.013
Mechanical ventilation time, h	19 (15,32)	16 (13,27)	<0.001
Chest drainage on the first postoperative day, mL	220 (160,310)	200 (150,280)	<0.001
Length of stay in the hospital, d	16 (13,21)	14 (12,18)	<0.001
ICU stays, h	72 (48,96)	72 (48,96)	0.004
Proportion of coagulation drugs and materials use^e	1887 (52.3)	1777 (49.2)	0.01
Hemoglobin^f, g/L	108 (99,116)	107 (97,117)	0.012
Hematocrit^f, l/L	0.32 (0.29,0.34)	0.31 (0.28,0.34)	<0.001
Platelets^f, ×10^9/L	112 (88,138)	115 (91,145)	<0.001
Creatinine^f, μmol/L	78 (66,92)	76 (66,90)	0.015

Notes: Continuous variables are reported as medians (25th percentile, 75th percentile), categorical variables reported as number (%). ^aFrom the beginning of CPB to the end. ^bFrom the beginning of the operation to the end. ^cIn the intensive care unit (ICU) after the operation. ^dThe occurrence of one or more of complications of prolonged mechanical ventilation, cerebrovascular accident, AKI, excessive chest drainage, pulmonary infection, IABP insertion. ^eIncludes fibrinogen, prothrombin complex, vitamin K1, recombinant factor VIIa, hemostatic gelatin sponge, fibrin glue, injectable thrombin and oxidized cellulose. ^fLaboratory test values shows the first postoperative test.

Abbreviations: AKI, acute kidney injury; CPB, cardiopulmonary bypass; ECMO, extracorporeal membrane oxygenation; IABP, intra-aortic balloon pump; ICU, intensive care unit; PBM, patient blood management; RBC, red blood cell.

Figure 2 Effect of PBM on transfusion outcomes stratified by the age. Categorical variables reported as number (%).

Abbreviations: CI, confidence interval; CPB, cardiopulmonary bypass; OR, odds ratio; PBM, patient blood management; P_int, P_interaction; RBC, red blood cell.

Figure 3 Effect of PBM on clinical outcomes stratified by the age. (A) Categorical dependent variables, (B) continuous dependent variables. For all categorical dependent variables and all continuous dependent variables, independent variables involved in these multivariable models were the same, incorporated age (aged 60–74/over age 75), PBM (pre-PBM/post-PBM), age-by-PBM interaction term, sex, EuroSCORE, EF, previous myocardial infarction, hyperlipidemia, chronic lung disease, renal dysfunction, previous cardiac surgery, hematocrit, platelets, creatinine, surgery type, CPB time. Continuous dependent variables are reported as medians (25th percentile, 75th percentile), categorical dependent variables reported as number (%).

Abbreviations: CI, confidence interval; IABP, intra-aortic balloon pump; ICU, intensive care unit; MD, mean difference; OR, odds ratio; PBM, patient blood management; P_int, P_interaction.